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Determination of culprit coronary artery branches using hemodynamic indices from angiographic images
Zhang Zhang1, Jun Chen, Shigeho Takarada
1Department of Radiological Sciences, School of Medicine, Medical Sciences I, B-140, University of California-Irvine, Irvine, CA, 92697-5000, USA.
Insights
This study shows that angiographic fractional flow reserve (FFRa) can accurately assess coronary artery disease severity using only images. This technique helps identify culprit arteries in myocardial ischemia without invasive pressure measurements.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Hemodynamics
Background:
- Myocardial ischemia diagnosis relies on identifying culprit coronary arteries.
- Current methods for assessing coronary artery disease severity can be invasive.
- Angiographic techniques offer a less invasive alternative for hemodynamic assessment.
Purpose of the Study:
- To determine culprit coronary arterial branches using coronary flow reserve (CFR) and fractional flow reserve (FFR) derived solely from angiographic images.
- To evaluate the diagnostic accuracy of angiographic CFR (CFRa) and FFR (FFRa) in various coronary artery disease models.
Main Methods:
- The study utilized 14 anesthetized swine with induced epicardial stenosis and microvascular disruption.
- Hemodynamic indices, including CFRa, relative CFRa, and FFRa, were calculated using first-pass distribution analysis (FPA) from angiographic data.
- Diagnostic abilities were assessed by comparing FFRa with pressure-derived FFR (FFRp) and analyzing receiver operating characteristic (ROC) curves.
Main Results:
- FFRa showed high accuracy, with mean differences from FFRp of -0.01 ± 0.21 (stenosis model) and 0.01 ± 0.18 (microcirculation model).
- Area under the ROC curve (AUC) for FFRa reached 0.918 in the stenosis model and 0.995 in the combined stenosis and microcirculation disruption model.
- The technique successfully measured hemodynamic indices in small coronary branches down to approximately 0.7 mm.
Conclusions:
- Angiographic fractional flow reserve (FFRa) derived from first-pass analysis is a viable, non-invasive method for assessing coronary artery disease.
- This technique accurately identifies the severity of disease in coronary arterial branches, potentially aiding in the diagnosis of myocardial ischemia.
- FFRa offers a promising tool for evaluating coronary artery stenosis and microvascular dysfunction using only standard angiographic images.
Abstract:
A recently reported angiographic technique for hemodynamic indices based on first-pass distribution analysis (FPA) could potentially be helpful for determining the culprit artery responsible for myocardial ischemia. The purpose of this study was to determinate the culprit coronary arterial branches based on coronary flow reserve (CFR) and fractional flow reserve (FFR) using only angiographic images. The study was performed in 14 anesthetized swine. Microspheres were injected into coronary arterial branches to create microvascular disruption. Stenosis was also created by inserting plastic tubings in LAD and LCX arterial branches. Adenosine was used to produce maximum hyperemia. Angiographic CFR (CFRa), relative angiographic CFR (rCFRa), and angiographic FFR (FFRa) were calculated by FPA. The diagnostic abilities of CFRa, rCFRa, and FFRa were compared in three models: (1) epicardial stenosis model (S), (2) microcirculation disruption model (M), and (3) combined(S + M) model by using the area under the ROC curve (AUC). The mean differences between FFRa and the pressure-derived FFR (FFRp) measurements were -0.01 ± 0.21 in S model (N = 37) and 0.01 ± 0.18 in M model (N = 53). From 225 measurements in S model, the AUCs for CFRa and FFRa were 0.720 and 0.918, respectively. From 262 measurements in M model and 238 measurements in (S + M) model, the AUCs for CFRa, rCFRa, FFRa were 0.744, 0.715, 0.959 and 0.806, 0.738, 0.995, respectively. The hemodynamic indices of the small branches (down to ~0.7 mm) could be measured using only angiographic image data. The application of FFRa could potentially provide a useful method to assess the severity of disease in coronary arterial branches.
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